Prior Use of Antiplatelet Therapy and Outcomes after Endovascular Therapy in Acute Ischemic Stroke Due to Large Vessel Occlusion: A Single-Center Experience

Abstract

Endovascular therapy (EVT) represents the gold standard treatment in patients affected by acute ischemic stroke (AIS) due to large vessel occlusion (LVO). Prior antiplatelet (APT) therapy might increase the risk of bleeding and modify the clinical outcome of AIS patients treated with EVT. Thus, we compared effectiveness and safety of EVT in Caucasian patients with and without previous use of APT agents. We recruited consecutive patients admitted to Udine University Hospital with AIS undergoing EVT from January 2015 to December 2017. The following outcomes were documented: successful recanalization, 3-month favorable outcome, symptomatic intracranial hemorrhage (sICH), parenchymal hematoma (PH), and 3-month mortality. The study population included 100 patients (mean age 70.1 ± 11.2 years, 58% males). At time of admission, 34 patients were taking APT agents. Patients on APT pretreatment were older, had more vascular risk factors, and showed higher levels of serum creatinine than APT naïve patients. Moreover, prior APT therapy was associated with a higher rate of pre-stroke disability and a more severe stroke at admission. Patients pretreated with APT had higher rates of successful recanalization (91.2% vs. 74.2%, p = 0.04). Prevalence of 3-month unfavorable outcome and 3-month mortality was significantly higher in APT-pretreated patients than in those without APT pretreatment. However, these associations were not confirmed on multivariable analyses. Prevalence of sICH and PH did not differ in the two groups. APT pretreatment is associated to successful recanalization rate, without increasing the risk of intracranial bleeding in patients with LVO undergoing EVT.

Acute ischemic stroke with cervical internal carotid artery steno-occlusive lesion: multicenter analysis of endovascular approaches

“…Pre-treatment antiplatelet therapy was used in 21 patients (41%), of these 17 patients (81%) had a 90-day mRS 0-2 vs 57% among those who did not use antiplatelet therapy (p = 0.081). This result is in accordance with the study by Valente et al who showed that prior use of antiplatelet therapy improves successful recanalization rate and does not increase the risk of intracranial bleeding in patients affected by AIS due to LVO and treated with EVT [26]. In patients who received pre-treatment antiplatelet therapy, a TICI score of 2B-3 was found in 86% of patients, slightly higher than that found in patients in whom pre-treatment antiplatelet therapy was not administered (80%).…”

Hypersensitive C-reactive protein-albumin ratio predicts symptomatic intracranial hemorrhage after endovascular therapy in acute ischemic stroke patients

“…To our knowledge, this study is the first to investigate the prospective association of HAR with sICH after endovascular treatment, and reveals that HAR could act as a useful predictor for sICH in patients undergoing endovascular treatment, according to the results of multivariate logistic regression, ROC analysis as well as nomogram analysis. Our study also found that previous antiplatelet use and fasting blood glucose level are associated with sICH after endovascular treatment, which is in line with other researches [ 25 , 27 , 28 ].…”

Hypersensitive C-Reactive Protein-Albumin Ratio Predicts Symptomatic Intracranial Hemorrhage After Endovascular Therapy in Acute Ischemic Stroke Patients

“…To our knowledge, this study is the rst to investigate the prospective association of HAR with sICH after endovascular treatment, and reveals that HAR could act as a useful predictor for sICH in patients undergoing endovascular treatment, according to the results of multivariate logistic regression, ROC analysis as well as nomogram analysis. Our study also found that previous antiplatelet use and fasting blood glucose level are associated with sICH after endovascular treatment, which is in line with other researches [26,28,29] .…”